August 30, 2009

Protecting Your Therapeutic Relationship and the Therapeutic Community

Posted in Borderline Personality Disorder, DID Education, DID/MPD, Dissociative Identity Disorder, Self Injury, therapy, Therapy and Counseling, Therapy Homework Ideas, Transference Issues, trauma therapist tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , at 2:44 pm by Kathy Broady


There are thousands of clinical therapists in the world.

However, of all the therapists in the world, only a few work with trauma and PTSD.

Of all the trauma therapists, only a few work with the areas of sexual abuse and severe trauma.

Of those therapists, only a few work with dissociative disorders, DID/MPD and DDNOS.

Of the DID therapists, only a very few work with issues relating to organized perpetrator groups.

And in that small subset of therapists, only a few work with more than two or three dissociative survivors at any one time.

And it is the rare therapist among that already vanishingly small number who stay in the field for more than a few years… or long enough to gain the experience they would need in order to be most helpful to the population of clients they serve,

So of all the thousands and thousands of therapists in the world, there are relatively very few who will have the kind of knowledge and experience that you are looking for when you need a specialist in the areas of trauma and dissociation.

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Why do so many therapists refuse to work in this area when there is so much need?

And why do so many therapists leave the field after committing years of dedication to dissociative survivors?

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It’s time to be honest.

First – please remember, I am one of the rare few who has stayed loyal and passionately dedicated to the fields of trauma and dissociation for more than 20 years.  It is hard to find trauma therapists with that much commitment to the dissociative population.  I am on your side – I will prove that over and over – but I am going to be honest.

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DID’ers are a very difficult population of people for a therapist to work with !!!!

Now don’t get me wrong.  Some of you are absolutely wonderful – without question, the most incredible heroes and the very most courageous people I have ever met.  Those of you in this category are absolute diamonds, and I really cannot say enough positive things about you.  You all are truly inspirational, and I am honored to work beside you.

Unfortunately, those who are genuinely dedicated to their therapy and who work hard to achieve their deepest healing are all too often undermined by the few survivors who are willing to do anything but work on their healing.

Oh, these survivors will SAY they are working in therapy…. They will CLAIM they are dedicated to their healing…. They go through the motions, and they spout all the right words.  To a point.  And then they don’t anymore.

Because in reality, this small number of survivors is more interested in hurting other people than they are in healing their own pain.  They are more interested in destroying others than they are in helping themselves.  They are willing to lie about anything or anyone just to get attention drawn to themselves.  They are very destructive and they are very sick.

And these destructive survivors could be costing you a lot more than you realize.

Ouch.

I am sure as a population, this is not pleasant to hear.  Please know that I am not saying this to all of you.

Those of you that are genuinely dedicated to your healing know exactly what I am talking about – I’m sure – because you have most likely already witnessed your healing resources being used up, beat up, and exhausted by fellow survivors whose intentions were far from honorable.  The survivors that do this are sabotaging those of you that are truly trying to heal, because the therapeutic field gets completely burnt out by “them” and ends up not having the time or energy or interest to work with you.  Many good therapists simply will not be willing to risk working with other survivors after they have had some bad experiences with these destructive survivors.

So… the survivors that are undermining your therapists are doing harm to themselves, to the therapists, and to you.  They are attacking, abusing, and destroying your therapeutic resources, leaving  you with less.  These “bad apples” are giving the whole dissociative population a bad name, and frankly, this kind of behavior should not be tolerated by any of us.

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Now what?

If you all want mental health professionals to stay working in the fields of trauma and dissociation, it is important to make that work worth it to them, and not a “nightmare” for them.

I am not saying that you have to feed the egos of the therapists, or provide support for them, or do any freaky weird boundary violations.  Therapists became therapists for intrinsic reasons of their own.  We don’t need y’all to “make it worth it” to us by what you give to us.

Therapists want you to make their work worth it by allowing them to genuinely do their job.  We want you to address your issues, work on your healing, stay focused on your system, be honest with your feelings, etc.  If you will do your job of focusing completely on your own healing, we as therapists will be thrilled with that.  Your genuine progress will be our reward.

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That being said, what can you do to protect the relationship you have with your therapist in particular? And how can you do your part to protect the resources available in the therapeutic community, so that therapists are more motivated to enter and remain in the field, and more survivors have the opportunity to work with truly skilled professionals?

How can you separate yourself from those survivors that are destructive?

How can you make sure you are helping the problem, and not creating the problem?

Here are some ideas of what NOT to do:

  • Don’t lie to yourself and expect others to believe you.
  • Don’t lie to your therapist.  How can you heal if you are not honest in your sessions?
  • Don’t lie about a therapist.  Don’t believe lies about a therapist.
  • Don’t gossip about a therapist. Don’t believe gossip about a therapist.  Don’t spread unfounded false allegations.  Don’t chase off or destroy therapeutic resources with false accusations.
  • Don’t forget to examine your transference feelings, and recognize them as transference issues.  Don’t forget how projection, transference, displacement, and amnesia can affect your thinking. Work openly and genuinely on these issues instead of blaming the therapist.
  • Don’t attack a therapist because you are too afraid to address the real source of your anger.
  • Don’t let therapists become the “bad guys” in your definition.  Therapists are your helpers. They are there to help with your healing.  Learn quickly how to define the helpers from the hurters, and address that confusion as often as necessary.
  • Don’t assume that all “survivors” are automatically being honest with you (or themselves) when they are trashing a therapist.  Remember, they may be in the “hate” cycle of the love-hate dynamic.
  • Don’t assume that all “survivors” are working for the betterment of the survivor community.  Some so-called survivors are truly moles from the dark sides of the world, and are here to cause trouble in any way they can.
  • Don’t let your jealousies and insecurities consume you and destroy your focus.  If you want your therapist all to yourself, hire them to work 40 hrs per week at their full hourly rates.  If that is not an option, be mature enough to know your therapist is going to have other clients.

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Here are some ideas about what TO do:

  • Be genuinely honest with your yourself. The more honest you are, the more healing you will accomplish.
  • Be genuinely honest with your therapist. Your therapist can help best when they genuinely understand the issues.
  • Remember that your healing is to be focused on you, your behavior, your feelings, your mistakes, your strengths, your weaknesses, etc.  Your therapy is about you, so keep the topics focused on you, even when it is hard to look at yourself.
  • Do your own internal system homework in between sessions.  Your healing will progress as you put your own time and effort into it.
  • Be kind, appreciative, thankful, and polite.  This doesn’t mean to grovel or do penance.  Just use normal social manners and social politeness.
  • Remember that your therapist does not have to be your emotional (or physical) punching bag. If you are hitting too hard, redirect your anger towards your abusers, where it belongs.
  • Give yourself adequate time to work through the complexities of your healing process. An experienced therapist will not rush you, and it is truly ok for you to take as much time to heal as you need.
  • Separate yourself from other survivors that are troublemakers and instigators of negative drama.  Just like school days, if you hang out with people causing harm, you’ll end up doing the same, or being tangled in their web. Their poor behavior will cost you.  You can decide if that is worth it to you or not.
  • Ignore the drama queens determined to cause trouble in front of you.  If you refuse to buy into their antics, they will move on to other pastures.  If you give drama precedence over your own healing, you will not be progressing in your own healing.  Protect the entire dissociative community by supporting your therapeutic resources.
  • Remember to think for yourself.  All too often, survivors listen to any strong, authoritative voice that tells them what to do.  If someone is telling you negative things about your therapist, set a boundary, stop, and re-evaluate all sides of your situation.
  • Talk openly with your therapist about any concerns you have.  Give yourself the chance to problem-solve any difficulties or conflicts that arise.  Working through conflicts is an important part of your healing process, and it does not necessarily require a therapeutic rupture.

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If you can truly apply these guidelines, you will be honoring your own healing. You will also be showing respect to your individual therapist, protecting other ongoing therapeutic relationships, supporting the greater survivor community, and enhancing the larger therapeutic community.

Maybe most of you think that you are not actively involved in the destruction of the therapeutic resources, but if you support it, believe it, allow it to go on by your “friends”, etc, then you could be more involved than you realize. You can either help to maintain effective therapeutic resources, or you can allow their destruction.

It’s a conscious decision that each one of you has to make.

Everyone has to do their part in protecting the few therapeutic resources available for dissociative survivors.  You can choose to support the destructive people, or you can choose to kick them to the curb, and get along with your own healing.

Remember, if you genuinely focus on yourself and your own healing, then you are doing all you need to do.

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By:

Kathy Broady LCSW

www.AbuseConsultants.com

www.SurvivorForum.com

August 28, 2009

The Love / Hate Relationship for Borderlines

Posted in Borderline Personality Disorder, DID Education, DID/MPD, Dissociative Identity Disorder, mental health, Self Injury, therapy, trauma therapist tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , at 1:50 am by Kathy Broady


There are distinct differences between Dissociative Identity Disorder (DID) and Borderline Personality Disorder (DID).  There are many overlapping symptoms, and some therapists believe that all trauma survivors with DID are also BPD.  I, however, do not hold that perspective.

In my opinion, not all trauma survivors with DID are BPD.  However, I will guess that the greater portion of DID’ers are also borderline.  This makes the discussion of borderline behaviors an important topic for dissociative trauma survivors.

Borderline survivors are frequently characterized with black and white thinking, self-injury, impulsive behaviors, repeated crises, intense abandonment issues, suicidal behaviors, inappropriate anger, mood instability, irritability, paranoid thinking, an unstable self image, etc.  There are a wide variety of BPD behaviors that could be discussed over a series of posts.  I’ll save those topics for another day.

For this blog post, I want to focus on a particular aspect of BPD:  having a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. (see the DSM IV).

Unstable and intense relationships.

People with borderline personality disorder may idealize potential caregivers or lovers [or therapists] at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, is not “there” enough. These individuals can empathize with and nurture other people, but only with the expectation that the other person will “be there” in return to meet their own needs on demand. These individuals are prone to sudden and dramatic shifts in their view of others, who may alternately be seen as beneficent supports or as cruelly punitive. Such shifts often reflect disillusionment with a caregiver whose nurturing qualities had been idealized or whose rejection or abandonment is expected.
http://psychcentral.com/lib/2007/symptoms-of-borderline-personality-disorder

Ok, that’s a lot of psychobabble talk, so what does that mean?

This is when the BPD survivor alternates between thinking someone is wonderful – excellent – the very best, and then thinking that very same person is horrific – awful – horrible.  The BPD survivor will show or feel excessive attachment to a new person, and in a sense fall madly in love with this person.  They put this new person on a pedestal, believing the person to be more incredibly perfect and wonderful than they could possibly be in real life, and they crave constant attention and special recognition from their new perfect person.  (But don’t ask the BPD survivor to admit that. All too many BPD survivors deny their craving for more, more, more.)

But of course, no one can stay “perfect” for long.  The perfect person will inevitably do something that just doesn’t measure up.  Typically, the “errors” created by the perfect person are that they did not shower the BPD survivor with enough individual, specialized attention.  This is nearly always the fatal crime – just not doing enough to keep the attention-starved BPD person happy with unquestionable importance.  So, before they know it, the perfect person will suddenly become the hated target, responsible for all evils of the world.  And when BPD survivors swing from the feelings of intense positive adoration to the angry hateful place, they are willing to, and actually desirous of, utterly destroying the same person they once loved.

Does anyone remember the movie, Fatal Attraction?  That movie portrays a Hollywood version of the love-hate relationship experienced by borderlines.  Hollywood was extreme in their portrayal, of course, but the love-hate flip-flop is easily seen.

For trauma survivors with both BPD and DID, the love-hate flip-flop can happen quickly and easily.  Remember, as DID survivors, they are very used to switching and to containing opposite life perspectives in opposite extremes.  So, when the dissociative BPD feels abandoned by their treasured “good object” and becomes upset with them, the flip into hatred might not be that far away.

The abandonment can be experienced in any number of ways.  Being very sensitive to any rejection of intense connection they desire, simple things can be interpreted as huge emotional offences — for example, if the once perfect person sets limits by saying “no” to a specific request, or by not offering extra time, or by going away themselves. Even if the reasons for being away are valid, no reason is good enough – every reason still means they are left behind, and that is not acceptable.

Jealousy is frequently an intense motivator too.  When BPD survivors want a cherished relationship with their new perfect person, they have all kinds of jealous pangs if they believe someone else has a more treasured place than they do.   Instead of doing the work it takes to keep their own relationships in a positive place, they focus outwardly on relationships that belong to others, drowning in their jealousy and anger, and inevitably destroying the relationships they wanted to cherish.

For dissociative trauma survivors, the therapeutic relationship is an incredibly important relationship.  Developing and protecting this relationship is both central and crucial to the entire healing process.  DID’ers can spend years of time with their therapist, and cultivating the skills to keep this relationship in a workable, positive place is critical.

For BPD survivors, the therapeutic relationship is equally important.  However, these survivors often lack the skills needed to maintain positive long-term relationships, even with therapists.  Therapists very frequently become the target of the love-hate flip-flop dynamic.  Many therapists refuse to work with clients with BPD precisely because of this dynamic.

This love-hate borderline behavioral pattern should help to explain how any therapist can be the most dearest of therapists, and then a short time later, be the most hated. It’s a behavioral symptom of BPD. It doesn’t mean that the therapist is actually wonderful or horrible. It just means BPD survivor is acting out the black-white, love-hate, attachment-abandonment issue that is central to BPD.

When you know to look for it, you’ll see it happening all over the place in the trauma survivor population.

So when you hear someone attempting to destroy or bad-mouth someone else, consider the bigger clinical context of what this kind of behavior is about.

And please – work very hard to NOT do this to your therapist.  Your therapist will not likely become your worst enemy unless you make that happen.   Instead of destroying your cherished relationships, it is much better to protect them with all that you have.  Don’t believe lies.  Don’t tell yourself lies.  Remember who your therapist is and do not confuse your therapist with any other person (mother, father, perpetrator, etc). The disordered dynamics related to BPD are a complication, but they do not have to become an insuperable obstacle — you really can choose not to let these dynamics dominate your relationships, with your therapist or anyone else.

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By:

Kathy Broady LCSW

www.AbuseConsultants.com

www.SurvivorForum.com

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